Provider Demographics
NPI:1003149972
Name:BAECHEL, COREY (PSYD)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:BAECHEL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 KENDRICK ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-2726
Mailing Address - Country:US
Mailing Address - Phone:800-370-3651
Mailing Address - Fax:
Practice Address - Street 1:26 BEACON ST
Practice Address - Street 2:APT 47A
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-3803
Practice Address - Country:US
Practice Address - Phone:617-251-5867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MA9989103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program